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Rapid Progression of Uveitis and Alopecia Syphilitica in AIDS

Brandon J. Wong, BA1; Bryan K. Hong, MD2; Narsing A. Rao, MD2
[+] Author Affiliations
1Keck School of Medicine, University of Southern California, Los Angeles
2Doheny Eye Institute, University of Southern California, Los Angeles
JAMA Ophthalmol. 2014;132(4):506-508. doi:10.1001/jamaophthalmol.2014.7.
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There has been recent renewed interest in the ocular manifestations of syphilis, likely owing to the increased prevalence of patients with human immunodeficiency virus (HIV) coinfections in recent years. Ocular complications due to syphilis in these immunocompromised patients have been noted not only to progress faster but also to be more severe.1,2 We describe a young man, ultimately diagnosed as having syphilis and AIDS, who presented with florid panuveitis in the setting of progressive, secondary syphilitic dermatologic findings including alopecia of the scalp, eyebrows, and eyelashes, oral ulcers, and maculopapular rash of the face.

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Figure 1.
Alopecia, Oral Ulcers, and Maculopapular Rash

A, Patient’s scalp at presentation with patchy “moth-eaten” alopecia. B, Erythematous oral ulcers on the hard and soft palates. C, Brown-pigmented, nontender, maculopapular rash on the patient’s face. D, Bilateral loss of eyebrows and madarosis.

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Figure 2.
Left Eye

A, Patient’s left eye at presentation (pharmacologically dilated) showing mild conjunctival hyperemia. B, Fundus photograph from a dilated fundus examination of the left eye showing a dense vitritis and apparent edema of the optic nerve head.

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